المؤلفون: Nogueira, Raul G, Pinheiro, Agostinho, Brinjikji, Waleed, Abbasi, Mehdi, Al-Bayati, Alhamza R, Mohammaden, Mahmoud H, Souza Viana, Lorena, Ferreira, Felipe, Abdelhamid, Hend, Bhatt, Nirav R, Kvamme, Peter, Layton, Kennith F, Delgado Almandoz, Josser E, Hanel, Ricardo A, Mendes Pereira, Vitor, Almekhlafi, Mohammed A, Yoo, Albert J, Jahromi, Babak S, Gounis, Matthew J, Patel, Biraj, Arturo Larco, Jorge L, Fitzgerald, Sean, Mereuta, Oana Madalina, Doyle, Karen, Savastano, Luis E, Cloft, Harry J, Thacker, Ike C, Kayan, Yasha, Copelan, Alexander, Aghaebrahim, Amin, Sauvageau, Eric, Demchuk, Andrew M, Bhuva, Parita, Soomro, Jazba, Nazari, Pouya, Cantrell, Donald Robert, Puri, Ajit S, Entwistle, John, Polley, Eric C, Frankel, Michael R, Kallmes, David F, Haussen, Diogo C

مصطلحات موضوعية: Ischemic stroke

الوصف: Background Mechanical thrombectomy (MT) has become standard for large vessel occlusions, but rates of complete recanalization are suboptimal. Previous reports correlated radiographic signs with clot composition and a better response to specific techniques. Therefore, understanding clot composition may allow improved outcomes. Methods Clinical, imaging, and clot data from patients enrolled in the STRIP Registry from September 2016 to September 2020 were analyzed. Samples were fixed in 10% phosphate-buffered formalin and stained with hematoxylin-eosin and Martius Scarlett Blue. Percent composition, richness, and gross appearance were evaluated. Outcome measures included the rate of first-pass effect (FPE, modified Thrombolysis in Cerebral Infarction 2c/3) and the number of passes. Results A total of 1430 patients of mean±SD age 68.4±13.5 years (median (IQR) baseline National Institutes of Health Stroke Scale score 17.2 (10.5–23), IV-tPA use 36%, stent-retrievers (SR) 27%, contact aspiration (CA) 27%, combined SR+CA 43%) were included. The median (IQR) number of passes was 1 (1–2). FPE was achieved in 39.3% of the cases. There was no association between percent histological composition or clot richness and FPE in the overall population. However, the combined technique resulted in lower FPE rates for red blood cell (RBC)-rich (P<0.0001), platelet-rich (P=0.003), and mixed (P<0.0001) clots. Fibrin-rich and platelet-rich clots required a higher number of passes than RBC-rich and mixed clots (median 2 and 1.5 vs 1, respectively; P=0.02). CA showed a trend towards a higher number of passes with fibrin-rich clots (2 vs 1; P=0.12). By gross appearance, mixed/heterogeneous clots had lower FPE rates than red and white clots. Conclusions Despite the lack of correlation between clot histology and FPE, our study adds to the growing evidence supporting the notion that clot composition influences recanalization treatment strategy outcomes.

وصف الملف: text/html

العلاقة: http://jnis.bmj.com/cgi/content/short/16/5/466Test; http://dx.doi.org/10.1136/jnis-2023-020117Test

الإتاحة: https://doi.org/10.1136/jnis-2023-020117Test
http://jnis.bmj.com/cgi/content/short/16/5/466Test

المؤلفون: Nogueira, Raul G, Etter, Katherine, Nguyen, Thanh N, Ikeme, Shelly, Wong, Charlene, Frankel, Michael, Haussen, Diogo C, Del Rio, Carlos, McDaniel, Michael, Sachdeva, Rajesh, Devireddy, Chandan M, Al-Bayati, Alhamza R, Mohammaden, Mahmoud H, Doheim, Mohamed F, Pinheiro, Agostinho C, Liberato, Bernardo, Jillella, Dinesh V, Bhatt, Nirav R, Khanna, Rahul

المصدر: BMJ Medicine ; volume 2, issue 1, page e000207 ; ISSN 2754-0413

الوصف: Objective To measure the impact of the covid-19 pandemic on admissions to hospital and interventions for acute ischemic stroke and acute myocardial infarction. Design A retrospective analysis. Setting 746 qualifying hospitals in the USA from the Premier Healthcare Database. Participants Patients aged 18 years and older who were admitted to hospital with a primary diagnosis of acute ischemic stroke or acute myocardial infarction between 1 March 2019 and 28 February 2021. Main outcome measures Relative changes in volumes were assessed for acute ischemic stroke and acute myocardial infarction hospital admissions as well as intravenous thrombolysis, mechanical thrombectomy, and percutaneous coronary intervention (overall and for acute myocardial infarction only) across the first year of the pandemic versus the prior year. Mortality in hospital and length of stay in hospital were also compared across the first year of the pandemic versus the corresponding period the year prior. These metrics were explored across the different pandemic waves. Results Among 746 qualifying hospitals, admissions to hospital were significantly reduced after the covid-19 pandemic compared with before the pandemic for acute ischemic stroke (−13.59% (95% confidence interval−13.77% to −13.41%) and acute myocardial infarction (−17.20% (−17.39% to −17.01%)), as well as intravenous thrombolysis (−9.47% (−9.99% to −9.02%)), any percutaneous coronary intervention (−17.89% (−18.06% to −17.71%)), and percutaneous coronary intervention for acute myocardial infarction (−14.36% (−14.59% to −14.12%)). During the first year of the pandemic versus the previous year, the odds of mortality in hospital for acute ischemic stroke were 9.00% higher (3.51% v 3.16%; ratio of the means 1.09 (95% confidence interval (1.03 to 1.15); P=0.0013) and for acute myocardial infarction were 18.00% higher (4.81% v 4.29%; ratio of the means 1.18 (1.13 to 1.23); P<0.0001). Conclusions We observed substantial decreases in admissions to hospital with acute ischemic stroke and ...

الإتاحة: https://doi.org/10.1136/bmjmed-2022-000207Test

المؤلفون: Nogueira, Raul G., Pinheiro, Agostinho, Brinjikji, Waleed, Abbasi, Mehdi, Al-Bayati, Alhamza R., Mohammaden, Mahmoud H., Souza Viana, Lorena, Ferreira, Felipe, Abdelhamid, Hend, Bhatt, Nirav R., Kvamme, Peter, Layton, Kennith F., Delgado Almandoz, Josser E., Hanel, Ricardo A., Mendes Pereira, Vitor, Almekhlafi, Mohammed A., Yoo, Albert J., Jahromi, Babak S., Gounis, Matthew J., Patel, Biraj

المصدر: Journal of NeuroInterventional Surgery; May2024, Vol. 16 Issue 5, p466-470, 6p

مصطلحات موضوعية: THROMBOSIS surgery, PLATELET-rich fibrin, ERYTHROCYTES, TREATMENT effectiveness, REVASCULARIZATION (Surgery), ENDOVASCULAR surgery, RESPIRATORY aspiration, DESCRIPTIVE statistics, HISTOLOGICAL techniques, FORMALDEHYDE, THROMBECTOMY, DIGITAL image processing, STAINS & staining (Microscopy), CEREBRAL infarction, HEALTH outcome assessment, THROMBOSIS, EVALUATION

مستخلص: Background Mechanical thrombectomy (MT) has become standard for large vessel occlusions, but rates of complete recanalization are suboptimal. Previous reports correlated radiographic signs with clot composition and a better response to specific techniques. Therefore, understanding clot composition may allow improved outcomes. Methods Clinical, imaging, and clot data from patients enrolled in the STRIP Registry from September 2016 to September 2020 were analyzed. Samples were fixed in 10% phosphate-buffered formalin and stained with hematoxylin-eosin and Martius Scarlett Blue. Percent composition, richness, and gross appearance were evaluated. Outcome measures included the rate of first-pass effect (FPE, modified Thrombolysis in Cerebral Infarction 2c/3) and the number of passes. Results A total of 1430 patients of mean±SD age 68.4±13.5 years (median (IQR) baseline National Institutes of Health Stroke Scale score 17.2 (10.5-23), IV-tPA use 36%, stent-retrievers (SR) 27%, contact aspiration (CA) 27%, combined SR+CA 43%) were included. The median (IQR) number of passes was 1 (1-2). FPE was achieved in 39.3% of the cases. There was no association between percent histological composition or clot richness and FPE in the overall population. However, the combined technique resulted in lower FPE rates for red blood cell (RBC)-rich (P<0.0001), platelet-rich (P=0.003), and mixed (P<0.0001) clots. Fibrin-rich and platelet-rich clots required a higher number of passes than RBC-rich and mixed clots (median 2 and 1.5 vs 1, respectively; P=0.02). CA showed a trend towards a higher number of passes with fibrin-rich clots (2 vs 1; P=0.12). By gross appearance, mixed/heterogeneous clots had lower FPE rates than red and white clots. Conclusions Despite the lack of correlation between clot histology and FPE, our study adds to the growing evidence supporting the notion that clot composition influences recanalization treatment strategy outcomes. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of NeuroInterventional Surgery is the property of BMJ Publishing Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Al-Qudah, Abdullah M., Thirumala, Parthasarathy D., Anetakis, Katherine M., Crammond, Donald J., Algarni, Saleh A., AlMajali, Mohammad, Shandal, Varun, Gross, Bradley A., Lang, Michael, Bhatt, Nirav R., Al-Bayati, Alhamza R., Nogueira, Raul G., Balzer, Jeffrey R.

المصدر: Clinical Neurophysiology ; volume 161, page 69-79 ; ISSN 1388-2457

مصطلحات موضوعية: Physiology (medical), Neurology (clinical), Neurology, Sensory Systems

الإتاحة: https://doi.org/10.1016/j.clinph.2024.02.024Test
https://api.elsevier.com/content/article/PII:S138824572400049X?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S138824572400049X?httpAccept=text/plainTest

المؤلفون: Bhatt, Nirav R., Frankel, Michael R., Nogueira, Raul G., Fleming, Carol, Bianchi, Nicolas A., Morgan, Olivia, Chester, Katleen, English, Stephen W., Janocko, Nicholas, Navalkele, Digvijaya, Haussen, Diogo C.

المصدر: Stroke ; volume 52, issue 8, page 2530-2536 ; ISSN 0039-2499 1524-4628

الوصف: Background and Purpose: Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale is a helpful tool to triage patients with stroke in the field. However, data on its reliability in the prehospital setting are lacking. We aim to test the reliability of FAST-ED scale when used by paramedics in a mobile stroke unit covering a metropolitan area. Methods: As part of standard operating mobile stroke unit procedures, paramedics initially evaluated patients. If the event characterized a stroke alert, the FAST-ED score was determined by the paramedic upon patient contact (in-person) and then independently by a vascular neurologist (VN) immediately after paramedic evaluation (remotely/telemedicine). This allowed testing of the interrater agreement of the FAST-ED scoring performance between on-site prehospital providers and remotely located VN. Results: Of a total of 238 patients transported in the first 15 months of the mobile stroke unit’s activity, 173 were included in this study. Median age was 63 (interquartile range, 55.5–75) years and 52.6% were females. A final diagnosis of ischemic stroke was made in 71 (41%), transient ischemic attack in 26 (15%), intracranial hemorrhage in 15 (9%), whereas 61 (35%) patients were stroke mimics. The FAST-ED scores matched perfectly among paramedics and VN in 97 (56%) instances, while there was 0 to 1-point difference in 158 (91.3%), 0 to 2-point difference in 171 (98.8%), and 3 or more point difference in 2 (1.1%) patients. The intraclass correlation between VN and paramedic FAST-ED scores showed excellent reliability, intraclass correlation coefficient 0.94 (95% CI, 0.92–0.96; P <0.001). When VN recorded FAST-ED score ≥3, paramedics also scored FAST-ED≥3 in majority of instances (63/71 patients; 87.5%). A large vessel occlusion was identified in 16 (9.2%) patients; 13 occlusions were identified with a FAST-ED≥3 while 3 were missed. All of the latter patients had National Institutes of Health Stroke Scale score ≤5. Conclusions: We demonstrate excellent ...

الإتاحة: https://doi.org/10.1161/strokeaha.120.033775Test

المؤلفون: Bhatt, Nirav R., Backster, Anika, Ido, Moges S., Nogueira, Raul G., Bayakly, Rana, Wright, David W., Frankel, Michael R.

المصدر: Frontiers in Neurology ; volume 12 ; ISSN 1664-2295

مصطلحات موضوعية: Neurology (clinical), Neurology

الوصف: Objective: We sought to determine whether administration of Intravenous Thrombolysis (IVT) to patients with Acute Ischemic Stroke (AIS) within 60 min from hospital arrival is associated with lower 2-year mortality. Methods: This retrospective study was conducted among patients receiving IVT in hospitals participating in the Georgia Coverdell Acute Stroke Registry (GCASR) from January 1, 2008 through June 30, 2018. Two-year mortality data was obtained by linking the 2008–2018 Georgia Discharge Data System data and the 2008–2020 Georgia death records. We analyzed the study population in two groups based on the time from hospital arrival to initiation of IVT expressed as Door to Needle time (DTN) in a dichotomized (DTN ≤ 60 vs. > 60 min) fashion. Results: The median age of patients was 68 years, 49.4% were females, and the median NIHSS was 9. DTN ≤60 min was associated with lower 30-day [odds ratio (OR), 0.62; 95% CI, 0.52–0.73; P < 0.0001], 1-year (OR, 0.71; 95% CI, 0.61–0.83; P < 0.0001) and 2-year (OR, 0.76; 95% CI, 0.65–0.88; P = 0.001) mortality as well as lower rates of sICH at 36 h (OR, 0.57; 95% CI, 0.43–0.75; P = 0.0001), higher rates of ambulation at discharge (OR, 1.38; 95% CI, 1.25–1.53; P < 0.0001) and discharge to home (OR, 1.36; 95% CI, 1.23–1.52; P < 0.0001). Conclusion: Faster DTN in patients with AIS was associated with lower 2-year mortality across all age, gender and race subgroups. These findings reinforce the need for intensifying quality improvement measures to reduce DTN in AIS patients.

الإتاحة: https://doi.org/10.3389/fneur.2021.747185Test

المؤلفون: Mohammaden, Mahmoud H, Haussen, Diogo C, Pisani, Leonardo, Al-Bayati, Alhamza R, Bhatt, Nirav R, Jillella, Dinesh V, Bianchi, Nicolas A, Belagaje, Samir R, Frankel, Michael R, Nogueira, Raul G

المصدر: Interventional Neuroradiology; Aug2023, Vol. 29 Issue 4, p379-385, 7p

مصطلحات موضوعية: ISCHEMIC stroke, BLOOD pressure, LACUNAR stroke

مستخلص: Background and Purpose: Infarct growth rate (IGR) in acute ischemic stroke is highly variable. We sought to evaluate impact of symptom-reperfusion time on outcomes in patients undergoing mechanical thrombectomy (MT). Methods: A prospectively maintained database from January,2012-August,2020 was reviewed. All patients with isolated MCA-M1 occlusion who achieved complete reperfusion(mTICI2C-3), had a witnessed symptom onset and follow-up MRI were included. IGR was calculated as final infarct volume (FIV)(ml)/symptom onset to reperfusion time(hours) and was dichotomized according to the median value into slow-(SP) versus fast-progressors (FP). The primary analysis aimed to evaluate the impact of symptom-reperfusion time on 90-day mRS in SP and FP. Secondary analysis was performed to identify predictors of IGR. Results: A total of 137 patients were eligible for analysis. Mean age was 63 ± 15.4 years and median IGR was 5.13ml/hour. SP(n = 69) had higher median ASPECTS, lower median rCBF<30% lesion volume, higher proportion of favorable collaterals and hypoperfusion intensity ratio (HIR)<0.4, higher minimal mean arterial blood pressure before reperfusion, and lower rates of general anesthesia compared to FP(n = 68). Symptom-reperfusion time was comparable between both groups. SP had higher rates of 90-day mRS0-2(71.9%vs.38.9%,aOR;7.226,95%CI[2.431–21.482],p < 0.001) and lower median FIV. Symptom-reperfusion time was associated with 90-day mRS0-2 in FP (aOR;0.541,95%CI[0.309–0.946],p = 0.03) but not in SP (aOR;0.874,95%CI[0.742–1.056],p = 0.16). On multivariable analysis, high ASPECTS and favorable collaterals in the NCCT/CTA model, and low rCBF<30% and HIR<0.4 in the CTP model were independent predictors of SP. Conclusions: The impact of symptom-reperfusion time on outcomes significantly varies across slow-versus fast-progressors. ASPECTS, collateral score, rCBF<30%, and HIR define stroke progression profile. [ABSTRACT FROM AUTHOR]

: Copyright of Interventional Neuroradiology is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Broderick, Joseph P., Silva, Gisele Sampaio, Selim, Magdy, Kasner, Scott E., Aziz, Yasmin, Sutherland, Jocelyn, Jauch, Edward C., Adeoye, Opeolu M., Hill, Michael D., Mistry, Eva A., Lyden, Patrick D., Mocco, J, Smith, Elaine M., Hernandez-Jimenez, Macarena, Deljkich, Emir, Kamel, Hooman, Alemseged, Fana, Bates, Karen, Bhatt, Nirav R., Boltze, Johannes, Campbell, Bruce C.V., Favilla, Christopher, Fiorella, David, Grotta, James, Haddad, Walid, Heidt, Jeremy J., Liebeskind, David S., Lightfoot, Nathan, Jubin, Ronald, Khatri, Pooja, Lansberg, Maarten G., Lynch, John, Margolin, David H., Nguyen, Thanh N., Nogueira, Raul G., Samaniego, Edgar A., Saver, Jeffrey, Schwamm, Lee H., Sheth, Kevin N., Smith, Wendy J., Wadhwa, Manish, Wakhloo, Ajay K., Wechsler, Lawrence R., Xiong, Yunyun, Zachrison, Kori S.

مصطلحات موضوعية: R Medicine (General), RA Public aspects of medicine, RC Internal medicine

الوصف: The Stroke Treatment Academic Industry Roundtable (STAIR) convened a session and workshop regarding enrollment in acute stroke trials during the STAIR XII meeting on March 22, 2023. This forum brought together stroke physicians and researchers, members of the National Institute of Neurological Disorders and Stroke, industry representatives, and members of the US Food and Drug Administration to discuss the current status and opportunities for improving enrollment in acute stroke trials. The workshop identified the most relevant issues impacting enrollment in acute stroke trials and addressed potential action items for each. Focus areas included emergency consent in the United States and other countries; careful consideration of eligibility criteria to maximize enrollment and representativeness; investigator, study coordinator, and pharmacist availability outside of business hours; trial enthusiasm/equipoise; site start-up including contractual issues; site champions; incorporation of study procedures into standard workflow as much as possible; centralized enrollment at remote sites by study teams using telemedicine; global trials; and coenrollment in trials when feasible. In conclusion, enrollment of participants is the lifeblood of acute stroke trials and is the rate-limiting step for testing an exciting array of new approaches to improve patient outcomes. In particular, efforts should be undertaken to broaden the medical community’s understanding and implementation of emergency consent procedures and to adopt designs and processes that are easily incorporated into standard workflow and that improve trials’ efficiencies and execution. Research and actions to improve enrollment in ongoing and future trials will improve stroke outcomes more broadly than any single therapy under consideration.

وصف الملف: application/pdf

العلاقة: https://wrap.warwick.ac.uk/179243/1/WRAP-enhancing-enrollment-acute-stroke-trials-current-state-consensus-recommendations-2023.pdfTest; Broderick, Joseph P., Silva, Gisele Sampaio, Selim, Magdy, Kasner, Scott E., Aziz, Yasmin, Sutherland, Jocelyn, Jauch, Edward C., Adeoye, Opeolu M., Hill, Michael D., Mistry, Eva A. et al. (2023) Enhancing enrollment in acute stroke trials : current state and consensus recommendations. Stroke, 54 (10). pp. 2698-2707. doi:10.1161/STROKEAHA.123.044149 ISSN 0039-2499.

الإتاحة: https://doi.org/10.1161/STROKEAHA.123.044149Test
https://wrap.warwick.ac.uk/179243Test/
https://wrap.warwick.ac.uk/179243/1/WRAP-enhancing-enrollment-acute-stroke-trials-current-state-consensus-recommendations-2023.pdfTest

المؤلفون: Nogueira, Raul G, Pinheiro, Agostinho, Brinjikji, Waleed, Abbasi, Mehdi, Al-Bayati, Alhamza R, Mohammaden, Mahmoud H, Souza Viana, Lorena, Ferreira, Felipe, Abdelhamid, Hend, Bhatt, Nirav R, Kvamme, Peter, Layton, Kennith F, Delgado Almandoz, Josser E, Hanel, Ricardo A, Mendes Pereira, Vitor, Almekhlafi, Mohammed A, Yoo, Albert J, Jahromi, Babak S, Gounis, Matthew J, Patel, Biraj, Arturo Larco, Jorge L, Fitzgerald, Sean, Mereuta, Oana Madalina, Doyle, Karen, Savastano, Luis E, Cloft, Harry J, Thacker, Ike C, Kayan, Yasha, Copelan, Alexander, Aghaebrahim, Amin, Sauvageau, Eric, Demchuk, Andrew M, Bhuva, Parita, Soomro, Jazba, Nazari, Pouya, Cantrell, Donald Robert, Puri, Ajit S, Entwistle, John, Polley, Eric C, Frankel, Michael R, Kallmes, David F, Haussen, Diogo C

المساهمون: Radiology

المصدر: Journal of neurointerventional surgery ; England

مصطلحات موضوعية: Device, Stroke, Thrombectomy

الوصف: Background: Mechanical thrombectomy (MT) has become standard for large vessel occlusions, but rates of complete recanalization are suboptimal. Previous reports correlated radiographic signs with clot composition and a better response to specific techniques. Therefore, understanding clot composition may allow improved outcomes. Methods: Clinical, imaging, and clot data from patients enrolled in the STRIP Registry from September 2016 to September 2020 were analyzed. Samples were fixed in 10% phosphate-buffered formalin and stained with hematoxylin-eosin and Martius Scarlett Blue. Percent composition, richness, and gross appearance were evaluated. Outcome measures included the rate of first-pass effect (FPE, modified Thrombolysis in Cerebral Infarction 2c/3) and the number of passes. Results: A total of 1430 patients of mean±SD age 68.4±13.5 years (median (IQR) baseline National Institutes of Health Stroke Scale score 17.2 (10.5-23), IV-tPA use 36%, stent-retrievers (SR) 27%, contact aspiration (CA) 27%, combined SR+CA 43%) were included. The median (IQR) number of passes was 1 (1-2). FPE was achieved in 39.3% of the cases. There was no association between percent histological composition or clot richness and FPE in the overall population. However, the combined technique resulted in lower FPE rates for red blood cell (RBC)-rich (P<0.0001), platelet-rich (P=0.003), and mixed (P<0.0001) clots. Fibrin-rich and platelet-rich clots required a higher number of passes than RBC-rich and mixed clots (median 2 and 1.5 vs 1, respectively; P=0.02). CA showed a trend towards a higher number of passes with fibrin-rich clots (2 vs 1; P=0.12). By gross appearance, mixed/heterogeneous clots had lower FPE rates than red and white clots. Conclusions: Despite the lack of correlation between clot histology and FPE, our study adds to the growing evidence supporting the notion that clot composition influences recanalization treatment strategy outcomes.

العلاقة: Journal of NeuroInterventional Surgery; https://doi.org/10.1136/jnis-2023-020117Test; Nogueira RG, Pinheiro A, Brinjikji W, Abbasi M, Al-Bayati AR, Mohammaden MH, Souza Viana L, Ferreira F, Abdelhamid H, Bhatt NR, Kvamme P, Layton KF, Delgado Almandoz JE, Hanel RA, Mendes Pereira V, Almekhlafi MA, Yoo AJ, Jahromi BS, Gounis MJ, Patel B, Arturo Larco JL, Fitzgerald S, Mereuta OM, Doyle K, Savastano LE, Cloft HJ, Thacker IC, Kayan Y, Copelan A, Aghaebrahim A, Sauvageau E, Demchuk AM, Bhuva P, Soomro J, Nazari P, Cantrell DR, Puri AS, Entwistle J, Polley EC, Frankel MR, Kallmes DF, Haussen DC. Clot composition and recanalization outcomes in mechanical thrombectomy. J Neurointerv Surg. 2023 Jul 7:jnis-2023-020117. doi:10.1136/jnis-2023-020117. Epub ahead of print. PMID: 37419694.; http://hdl.handle.net/20.500.14038/52447Test

الإتاحة: https://doi.org/10.1136/jnis-2023-020117Test
https://doi.org/20.500.14038/52447Test
https://hdl.handle.net/20.500.14038/52447Test

المؤلفون: Doheim, Mohamed F, Al-Bayati, Alhamza R, Bhatt, Nirav R, Lang, Michael, Starr, Matthew, Rocha, Marcelo, Gross, Bradley A., Nogueira, Raul G

المصدر: Interventional Neuroradiology ; ISSN 1591-0199 2385-2011

الوصف: Background Intracranial atherosclerotic stenosis (ICAS) is associated with high risk of recurrent strokes despite best medical management (MM). We aimed to synthesize the evidence from randomized studies comparing intracranial stenting plus MM versus MM alone. Methods Comprehensive search of MEDLINE database was performed until May 2023. The data were extracted and pooled as risk ratio (RR) with 95% confidence interval (95% CI). Results We included three multicenter RCTs totaling 919 patients. As compared to MM alone, intracranial stenting was associated with statistically significant higher risks of any stroke or death (RR = 2.93, 95%CI [1.80–4.78], p < 0.0001), stroke in the same territory of qualifying artery (RR = 3.56, 95%CI [1.97–6.44], p < 0.0001), any ischemic stroke (RR = 2.22, 95%CI [1.27–3.87], p = 0.005), hemorrhagic stroke (RR = 13.49, 95%CI [2.59–70.15], p = 0.0002), and death (RR = 5.43, 95%CI [1.21–24.40], p = 0.003) within 30 days of randomization. There was a persistent lack of benefit and signals of harm at the last follow up within 1–3 years: any stroke or death (RR = 1.57, 95%CI [0.92–2.67], p = 0.1), stroke in the same territory of qualifying artery (RR = 1.84, 95%CI [0.97–3.50], p = 0.06), any ischemic stroke (RR = 1.56, 95%CI [1.11–2.20], p = 0.01), death (RR = 1.61, 95%CI [0.77–3.38], p = 0.2). The cumulative rate of stroke in the same territory of qualified artery with MM alone within the 1–3-year follow up was lower than expected, with only 47 out of the 450 (10.4%) MM alone patients suffering such events. Conclusion The findings from this meta-analysis do not recommend stenting as a routine care option for the broader symptomatic ICAS patient population. The rates of recurrent strokes in ICAS patients managed with aggressive MM do not seem to be as high as anticipated. Additional multicenter RCTs including safer devices, larger sample sizes, and patients at higher risk of recurrent events are warranted.

الإتاحة: https://doi.org/10.1177/15910199231206044Test